Thursday, November 28, 2013

Thanksgiving 2013

Thomas Jefferson once proclaimed to fellow Virginian, James Monroe, "My God! How little do my fellow countrymen know what precious blessings they are in possession of, and which no other people on earth enjoy!"

Lets all give thanks.

Happy Thanksgiving!

Saturday, November 23, 2013

DSB

Medical record reviews have consistently shown that 75% of patients who are given a diagnosis of an upper respiratory infection (URI's) and greater than 90% of those given a diagnosis of acute sinusitis leave a medical encounter with a prescription for antibiotics.

This is despite the fact that studies have consistently shown that virtually 100% of URI's and 70% of those with acute sinusitis will improve without antibiotics.

One pediatrician attributes this to drug-seeking behavior (DSB). She also attributes this to the abundance of walk-in clinics that may spend a minute or two with a patient prior to sending them on their way with an antibiotic prescription.

She notes that "when patients don't get what they want from me, they often turn to urgent care clinics instead to get the prescriptions they are seeking."

The pediatrician "shamefully admits to having caved under pressure at times and written a prescription that she didn't feel good about writing."

I admit to the same.

Shame on us and shame on the drug seekers!

I'm not overly optimistic things will ever change in this regard.

It's estimated that one complication from either a URI or acute sinusitis is prevented for every 4000 antibiotic prescriptions written.

Everyone is so concerned about being part of the 0.025% of folks who may have a complication instead of the 99.975% of those who don't.

White and clean?

A recent article in one of our medical newspapers reported that when surveyed, patients still prefer for his/her doctor to appear professionally dressed, including wearing a white lab coat.

I suspect those surveyed may have had other opinions if given additional data.

Many studies over the years have shown that medical personnel change their lab coats very infrequently. In one study, over 50% reported less than once a week. Other studies have shown that many antibiotic resistant bacteria, such as C. Difficile and MRSA, can thrive on a lab coat for a month or two if the coat is not properly cleaned.

I stopped wearing a lab coat years ago for this very reason.

I ALWAYS think of this whenever I see my colleagues who still do.

Poor choice of time?

An advanced stage of brain cancer is never a good thing.

A study recently released showed that those with stage IV Glioblastoma had a median survival of only 6.5 months if they were not given access to the highest level of treatment available that includes aggressive surgery, radiation and chemotherapy.

The median survival in those aggressively treated was still less than 12 months.

Median survival is defined as the time after which 50% of people with a particular condition are still living, and 50% have died. For example, a median survival of 6 months would indicate that after 6 months, 50% of people with that condition would be alive, and 50% would have passed away.

I've seen a few folks who have gone the aggressive treatment route.

I know it's hard to know what any of us would choose in a situation such as this, but I haven't been convinced yet that an increased quality of life is experienced by those you get to have their median survival increased by 5 months.

But those choosing the aggressive route definitely get to spend more money and an increased amount of time in doctors offices and at diagnostic/treatment centers.

That doesn't sound like fun to me.

Thursday, November 21, 2013

Medications to the rescue!

Mr. B. is a 76 year old with a steady girlfriend for the last 6 months.

"She's a much younger woman (age 66)."

He inquired about what options might be available to allow him to perform intimately again.

I first inquired if they had decided on this together.

"She's ready," he said, "she just told to make sure I got something that would at least let me finish whatever I started."

Thursday, November 14, 2013

An uplifting tale (forwarded by my brother)

A 92-year-old, well-poised and proud man, who is fully dressed each morning by eight o'clock, with his hair fashionably combed and shaved perfectly, even though he is legally blind, moved to a nursing home today.

His wife of 70 years recently passed away, making the move necessary. After many hours of waiting patiently in the lobby of the nursing home, he smiled sweetly when told his room was ready.

As he maneuvered his walker to the elevator, I provided a visual description of his tiny room, including the eyelet sheets that had been hung on his window.

"I love it," he stated with the enthusiasm of an eight-year-old having just been presented with a new puppy.

"Mr. Jones, you haven't seen the room; just wait.."

"That doesn't have anything to do with it," he replied.

"Happiness is something you decide on ahead of time."

"Whether I like my room or not doesn't depend on how the furniture is  arranged .. it's how I arrange my mind.  I already decided to love it."

"It's a decision I make every morning when I wake up. I have a choice; I can spend the day in bed recounting the difficulty I have with the parts of my body that no longer work, or get out of bed and be thankful for the ones that do."

"Each day is a gift, and as long as my eyes open, I'll focus on the new day and all the happy memories I've stored away..  Just for this time in my life..."

"Old age is like a bank account. You withdraw from what you've put in."

"So, my advice to you would be to deposit a lot of happiness in the bank account of memories!"
  

"I'm still depositing."

  "Remember the five simple rules to be happy:


    1. Free your heart from hatred.


    2. Free your mind from worries.


    3. Live simply.


    4. Give more.


    5. Expect less."

Monday, November 11, 2013

Yum, yum!

I've been seeing a lot of fast food signs recently noting to a bargain on chicken nuggets.

Here's a interesting study to digest:

http://ftpcontent4.worldnow.com/wlbt/PDF/ChickenLittle.pdf

Microscopic examinations on nuggets from two different fast food chains revealed:

Nugget from chain #1: 50% skeletal muscle, with the remainder composed primarily of fat, with some blood vessels and nerve present

Nugget from chain #2: approximately 40% skeletal muscle with generous quantities of fat and other tissue, including connective tissue and bone spicules

This is the answer to why nuggets are only a $1 if ever asked.

Saturday, November 9, 2013

Eat, sleep and be active

Army Surgeon General Lt. Gen. Patricia D. Horoho recently announced the implementation of the Performance Triad pilot program for the troops.

Healthier soldiers are better soldiers.

The program, at its core, recognizes the importance of adequate sleep, regular physical activity and balanced nutrition on the health and optimal performance of ANY person.

Seems pretty obvious but it's amazing how many us just don't seem to get it.

Marriage Isn't For You

Here's an excellent short article by Seth Adam Smith:

http://sethadamsmith.com/2013/11/02/marriage-isnt-for-you/

I hope I'll offer similar thoughts to my own children down the road...

Thursday, November 7, 2013

A genitalogist

A 70 year old male wanted to know if he should go see a "penis-machinist (a urologist)."

He laughed.

So did I.

"My wife used to get upset whenever I would call him a peckerologist, so I needed to come up with another name."

Saturday, November 2, 2013

Knowing they are loved

A good friend recently commented, after reading a post in this blog (Home sweet home), that he has always felt guilty about placing his Mother in a nursing home prior to her death.

I completely understand how he's feeling.

My Dad also spent some time in a nursing facility before he died.

I've often felt guilt as well.

Every situation is different.

Not all families have the ability to keep a loved one at home.

Sleep deprivation and other issues (behavioral issues of Dementia (outbursts, impulsivity, loss of social graces, etc.), sun-downing, absence of multiple caregivers, etc.) can completely wear the most motivated of caregiver(s) down and render attempts at home care more problematic and dangerous than care in a nursing facility.

My mother spent a considerable amount of time at his facility everyday as did my brother who lived relatively near-by.

Given a multitude of factors however, including the ones mentioned above, keeping my Dad at home near the end of his life was not possible for us.

I'm sure my friends Mother knew how much she was loved, as did my Dad.

This is the most important thing at the end of life.

Staggering statistics

When I was accepted for admission into the University of Virginia (in 1977) 10,000 students applied for a first year class of 2500 students.

Last year, over 30,000 students applied for a first year class of 3500 students.

So, in 36 years, the first year class size increased by 40% while the number of applicants increased by 300%.

Did I do my math correctly?

The application deadline for the class of 2018 was yesterday.

Best of luck to all who applied!